1
|
Stewart B, Byrne M, Levy M, Horberg MA, Monroe AK, Castel AD. The Association of Mental Health and Substance Use With Retention in HIV Care Among Black Women in Washington, District of Columbia. Womens Health Issues 2024; 34:250-256. [PMID: 38184379 PMCID: PMC11116077 DOI: 10.1016/j.whi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Black women with HIV are impacted by mental health and substance use disorders alongside barriers to care. The impact of these disorders on retention in care, a crucial step of the HIV care continuum, has not been well-studied. We examined the association between these disorders and retention in care over a 2-year period. METHODS Data from January 1, 2011, to June 30, 2019, were obtained from the DC Cohort, an observational HIV study in Washington, District of Columbia. We examined the associations between mental health (i.e., mood-related or trauma-related) or substance use disorders, separately, on not being retained in HIV care over a 2-year interval post-enrollment among non-Hispanic Black women with HIV. Multivariate logistic regression with adjusted odds ratios (aORs) for sociodemographic and clinical variables was used to quantify the association of 1) having a confirmed mental health or substance use disorder and 2) not being retained in care. RESULTS Among the 2,181 women in this analysis, 690 (31.64%) were not retained in care. The prevalence of a mood-related disorder (39.84%) was higher compared with a substance use (16.19%) or trauma-related disorder (7.75%). Age per a 10-year increase (aOR 0.87; confidence interval [CI] 0.80, 0.94) and a mood-related disorder diagnosis (aOR 0.72; CI: 0.59, 0.88) were inversely associated with not being retained in care. CONCLUSION Mood-related disorders were prevalent among Black women with HIV in Washington, District of Columbia, but were not associated with worse retention in care. Future studies should examine key facilitators for Black women with HIV and coexisting mood-related disorders and how they impact retention in care.
Collapse
Affiliation(s)
- Bianca Stewart
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | | | - Michael A Horberg
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| |
Collapse
|
2
|
Orchowski LM, Gobin RL, Zlotnick C. Correlates of Condom use Among Community College Women: The Role of Victimization, Substance Use, and Mental Health Symptoms. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2018; 13:170-189. [PMID: 30881260 PMCID: PMC6413526 DOI: 10.1080/15546128.2018.1443302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research is needed to understand intersecting health risks among community college students. Applying a syndemic framework, the present research explored childhood sexual victimization, adolescent sexual victimization, intimate partner violence (IPV), marijuana use, alcohol consumption, and symptoms of depression and post-traumatic stress disorder as additive as well as interactive correlates of women's condom use. Questionnaires were administered to a sample of 212 women between the ages of 18 to 24 attending a community college. A series of logistic regression analyses documented that an increased number of psychosocial risk factors was associated with not using a condom during sexual intercourse. Experiencing both adolescent sexual victimization and lifetime intimate partner violence (IPV), compared to experiencing one form of victimization, increased the odds of not using a condom. Endorsing both lifetime IPV and past year marijuana use, compared to endorsing only one of these factors, also increased the odds of not using a condom. These findings highlight the importance of targeting intersections between adolescent sexual victimization, IPV, marijuana use, and sexual risk behavior when developing educational programs for community college women.
Collapse
Affiliation(s)
- Lindsay M Orchowski
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Robyn L Gobin
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| |
Collapse
|
3
|
Blanco L, Nydegger LA, Camarillo G, Trinidad DR, Schramm E, Ames SL. Neurological changes in brain structure and functions among individuals with a history of childhood sexual abuse: A review. Neurosci Biobehav Rev 2015; 57:63-9. [PMID: 26363666 DOI: 10.1016/j.neubiorev.2015.07.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 07/19/2015] [Accepted: 07/27/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Review literature focused on neurological associations in brain structure among individuals with a history of childhood sexual abuse (CSA). METHODOLOGY A review of literature examining physiological irregularities in brain structures of individuals with a history of CSA was conducted. RESULTS Results revealed that a history of CSA was associated with irregularities in the cortical and subcortical regions of the brain. These irregularities have been recognized to contribute to various cognitive, behavioral, and psychological health outcomes later in life. Age of CSA onset was associated with differential neurological brain structures. CONCLUSION Mental and behavioral health problems such as anxiety, depression, substance abuse, dissociative disorders, and sexual dysfunction are associated with CSA and may persist into adulthood. Research depicting the associations of CSA on neurological outcomes emphasizes the need to examine the biological and subsequent psychological outcomes associated with CSA. Early intervention is imperative for CSA survivors.
Collapse
Affiliation(s)
- Lyzette Blanco
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, United States; University of California, Davis, CA, United States.
| | - Liesl A Nydegger
- Center for Aids Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, United States; University of California, Davis, CA, United States
| | - Giselle Camarillo
- Center for Aids Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, United States; University of California, Davis, CA, United States
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States; University of California, Davis, CA, United States
| | - Emily Schramm
- Fred Finch Youth Center, Oakland, CA, United States; University of California, Davis, CA, United States
| | - Susan L Ames
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, United States; University of California, Davis, CA, United States
| |
Collapse
|
4
|
Myers HF, Wyatt GE, Ullman JB, Loeb TB, Chin D, Prause N, Zhang M, Williams JK, Slavich GM, Liu H. Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2015; 7:243-51. [PMID: 25961869 PMCID: PMC4445692 DOI: 10.1037/a0039077] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study examined the utility of a lifetime cumulative adversities and trauma model in predicting the severity of mental health symptoms of depression, anxiety, and posttraumatic stress disorder. We also tested whether ethnicity and gender moderate the effects of this stress exposure construct on mental health using multigroup structural equation modeling. A sample of 500 low-socioeconomic status African American and Latino men and women with histories of adversities and trauma were recruited and assessed with a standard battery of self-report measures of stress and mental health. Multiple-group structural equation models indicated good overall model fit. As hypothesized, experiences of discrimination, childhood family adversities, childhood sexual abuse, other childhood trauma, and chronic stresses all loaded on the latent cumulative burden of adversities and trauma construct (CBAT). The CBAT stress exposure index in turn predicted the mental health status latent variable. Although there were several significant univariate ethnic and gender differences, and ethnic and gender differences were observed on several paths, there were no significant ethnic differences in the final model fit of the data. These findings highlight the deleterious consequences of cumulative stress and trauma for mental health and underscore a need to assess these constructs in selecting appropriate clinical interventions for reducing mental health disparities and improving human health.
Collapse
Affiliation(s)
- Hector F Myers
- Center for Medicine, Health, & Society and Psychology, Vanderbilt University
| | - Gail E Wyatt
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | - Tamra B Loeb
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Dorothy Chin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Nicole Prause
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Muyu Zhang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - John K Williams
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology, University of California
| | - Honghu Liu
- School of Dentistry, University of California, Los Angeles
| |
Collapse
|
5
|
Lanier L, DeMarco R. A synthesis of the theory of silencing the self and the social ecological model: understanding gender, race, and depression in African American women living with HIV infection. AIDS Patient Care STDS 2015; 29:142-9. [PMID: 25614997 DOI: 10.1089/apc.2014.0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The challenges that face African American women living with HIV are immense. African American women continue to be disproportionately infected and affected by this chronic and life-threatening infection in a complex context of individual experience, interactions with the environment, formal and informal support systems, and cultural belief systems. This article identifies the Theory of Silencing the Self (STS) and a widely known model, the Social Ecological Model (SEM), as a synthesized explanatory framework in helping nurses understand how to address research questions and clinical care that is congruent with the experience of African American women living with HIV infection. In synthesizing the components of these two frameworks, an explanation of the relationship between disempowerment and depression in this population will be uncovered as a key component to making relationships at the individual, family, and community level better. Helping African American women living with HIV infection to explore and address how choosing to be silent across their life systems will advance healthcare adherence as we currently know it to improved self-management of a chronic, gender-specific, culturally-bound experience of depression.
Collapse
Affiliation(s)
- Latrona Lanier
- Department of Nursing, Darton State College, Albany, Georgia
| | - Rosanna DeMarco
- Department of Nursing, College of Nursing and Health Sciences, University Massachusetts Boston, Boston, Massachusetts
| |
Collapse
|
6
|
Prevalence, incidence, and persistence of psychiatric and substance use disorders among mothers living with HIV. J Acquir Immune Defic Syndr 2014; 65:526-34. [PMID: 24759063 DOI: 10.1097/qai.0000000000000070] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate prevalence, incidence, remission, and persistence of psychiatric and substance use disorders among HIV-infected mothers and identify biopsychosocial correlates. METHODS HIV-infected mothers (n = 1223) of HIV-exposed uninfected children enrolled in a prospective cohort study; HIV-uninfected mothers (n = 128) served as a comparison group. Mothers provided sociodemographic and health information and completed the Client Diagnostic Questionnaire (CDQ). Prevalence of any psychiatric or substance use disorder at initial evaluation was compared between the 2 groups. Incident, remitting, and persisting disorders were identified for 689 mothers with HIV who completed follow-up CDQs. We used logistic regression to evaluate adjusted associations of biopsychosocial characteristics with presence, incidence, remission, and persistence of disorders. RESULTS Thirty-five percent of mothers screened positive for any psychiatric or substance use disorder at initial evaluation, with no difference by maternal HIV status (P = 1.00). Among HIV-infected mothers, presence of any disorder was associated with younger age [adjusted odds ratio (aOR): 1.39; 95% CI: 1.09 to 1.75], single parenthood (aOR: 1.35; 95% CI: 1.08 to 1.68), and functional limitations (aOR: 2.29; 95% CI: 1.81 to 2.90). Incident disorders were associated with functional limitations (aOR: 1.92; 95% CI: 1.10 to 3.30). Among HIV-infected mothers with a disorder at initial evaluation (n = 238), 61% had persistent disorders. Persistent disorders were associated with lower income (aOR: 2.44; 95% CI: 1.33 to 4.76) and functional limitations (aOR: 3.19; 95% CI: 1.87 to 5.48). Receipt of treatment for any disorder was limited: 4.5% at study entry, 7% at follow-up, 5.5% at both entry and follow-up. CONCLUSIONS Psychiatric and substance use disorders remain significant comorbid conditions among HIV-infected mothers and require accessible evidence-informed treatment.
Collapse
|
7
|
Peltzer K, Pengpid S, Tiembre I. Mental health, childhood abuse and HIV sexual risk behaviour among university students in Ivory Coast. Ann Gen Psychiatry 2013; 12:18. [PMID: 23758850 PMCID: PMC3682872 DOI: 10.1186/1744-859x-12-18] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/24/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little focus has been paid to the role of poor mental health and childhood abuse among young people with regard to human immunodeficiency virus (HIV) risk behaviour and HIV prevention in Africa. The aim of this study was to determine the association between mental health, childhood abuse and HIV sexual risk behaviour among a sample of university students in Ivory Coast. METHODS A cross-sectional survey was conducted with undergraduate students that were recruited randomly from classes at the Félix Houphouët Boigny University of Cocody. The sample included 824 university students (50% men and 50% women), with a mean age of 23.7 years (SD = 2.7). RESULTS Of the 824 university students who completed the survey, 17.6% reported depression, 10.8% screened positive for post-traumatic stress disorder, 8.3% reported at least monthly heavy episodic drinking, 13.5% reported childhood physical abuse and 4.7% sexual abuse, 33.9% had two or more sexual partners in the past 12 months, 66.3% had inconsistent condom use, 23.6% had alcohol use in the context of sex and 16.7% had a history of a sexually transmitted infection In multivariable analysis among men, lack of religiousness and alcohol use in the context of sex were associated with HIV risk behaviour, and among women, poorer family background, experience of sexual and physical partner violence, alcohol use in the context of sex and depression were associated with HIV risk behaviour. CONCLUSIONS Poor mental health (depression) including alcohol use and partner violence was found to be associated with HIV risk behaviour. Coordinated mental health and sexual and reproductive health services to meet the needs of university students would be desirable.
Collapse
Affiliation(s)
- Karl Peltzer
- HIV/AIDS, STI and TB (HAST) Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria, South Africa.
| | | | | |
Collapse
|
8
|
Brumsey AD, Joseph NT, Myers HF, Ullman JB, Wyatt GE. Modeling the Relationship between Trauma and Psychological Distress among HIV-Positive and HIV-Negative Women. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2013; 5:69-76. [PMID: 24587871 DOI: 10.1037/a0022381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated the association between cumulative exposure to multiple traumatic events and psychological distress, as mediated by problematic substance use and impaired psychosocial resources. A sample of HIV-positive and HIV-negative women were assessed for a history of childhood and adult sexual abuse and non-sexual trauma as predictors of psychological distress (i.e., depression, non-specific anxiety, and posttraumatic stress), as mediated by problematic alcohol and drug use and psychosocial resources (i.e., social support, self-esteem and optimism). Structural equation modeling confirmed that cumulative trauma exposure is positively associated with greater psychological distress, and that this association is partially mediated through impaired psychosocial resources. However, although cumulative trauma was associated with greater problematic substance use, substance use did not mediate the relationship between trauma and psychological distress.
Collapse
Affiliation(s)
| | | | - Hector F Myers
- Department of Psychology, University of California, Los Angeles
| | - Jodie B Ullman
- Department of Psychology, California State University, San Bernardino
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience, University of California, Los Angeles
| |
Collapse
|
9
|
Abstract
Women bear an increasing burden of the HIV epidemic and face high rates of morbidity and mortality. Trauma has been increasingly associated with the high prevalence and poor outcomes of HIV in this population. This meta-analysis estimates rates of psychological trauma and posttraumatic stress disorder (PTSD) in HIV-positive women from the United States. We reviewed 9,552 articles, of which 29 met our inclusion criteria, resulting in a sample of 5,930 individuals. The findings demonstrate highly disproportionate rates of trauma exposure and recent PTSD in HIV-positive women compared to the general population of women. For example, the estimated rate of recent PTSD among HIV-positive women is 30.0% (95% CI 18.8-42.7%), which is over five-times the rate of recent PTSD reported in a national sample of women. The estimated rate of intimate partner violence is 55.3% (95% CI 36.1-73.8%), which is more than twice the national rate. Studies of trauma-prevention and trauma-recovery interventions in this population are greatly needed.
Collapse
|
10
|
Gómez CA. Preventing HIV in U.S. women and girls: a call for social action. Womens Health Issues 2012; 21:S287-94. [PMID: 22055680 DOI: 10.1016/j.whi.2011.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 11/30/2022]
Abstract
Successes in HIV prevention efforts in the U.S. have resulted in drastic reductions in the number of new infections in the U.S. among white gay men and injection drug users, a stabilization in overall annual rates of new HIV infections, and near eradication of mother-to child transmission of HIV. Despite this remarkable progress, the proportion of AIDS cases in women has slowly, quietly, and steadily increased from 7% in 1985 to 25% in 2008. The fact the prevention efforts have not reduced HIV spread among women suggests that targeting the individual behaviors of women to prevent HIV acquisition is not a sufficiently effective public health strategy. Interventions that more broadly address the needs of women and their families, and address the contextual factors in which HIV risk occurs are more likely to lead to measurable and sustainable progress. Over the past 30 years, we have seen the U.S. HIV epidemic in women become similar to patterns of HIV risk among women in the developing world. In 2009, 85% of women who acquired HIV became infected through sex with a man and the majority (83%) of them were non-white women. Efforts to understand these immense disparities and create gender-responsive strategies must be a priority within our National HIV/AIDS Strategy.
Collapse
Affiliation(s)
- Cynthia A Gómez
- Health Equity Institute, San Francisco State University, San Francisco, California 94132, USA.
| |
Collapse
|
11
|
Prevalence of psychological trauma and association with current health and functioning in a sample of HIV-infected and HIV-uninfected Tanzanian adults. PLoS One 2012; 7:e36304. [PMID: 22606252 PMCID: PMC3351441 DOI: 10.1371/journal.pone.0036304] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 04/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In high income nations, traumatic life experiences such as childhood sexual abuse are much more common in people living with HIV/AIDS (PLWHA) than the general population, and trauma is associated with worse current health and functioning. Virtually no data exist on the prevalence or consequences of trauma for PLWHA in low income nations. METHODOLOGY/PRINCIPAL FINDINGS We recruited four cohorts of Tanzanian patients in established medical care for HIV infection (n = 228), individuals newly testing positive for HIV (n = 267), individuals testing negative for HIV at the same sites (n = 182), and a random sample of community-dwelling adults (n = 249). We assessed lifetime prevalence of traumatic experiences, recent stressful life events, and current mental health and health-related physical functioning. Those with established HIV infection reported a greater number of childhood and lifetime traumatic experiences (2.1 and 3.0 respectively) than the community cohort (1.8 and 2.3). Those with established HIV infection reported greater post-traumatic stress disorder (PTSD) symptomatology and worse current health-related physical functioning. Each additional lifetime traumatic experience was associated with increased PTSD symptomatology and worse functioning. CONCLUSIONS/SIGNIFICANCE This study is the first to our knowledge in an HIV population from a low income nation to report the prevalence of a range of potentially traumatic life experiences compared to a matched community sample and to show that trauma history is associated with poorer health-related physical functioning. Our findings underscore the importance of considering psychosocial characteristics when planning to meet the health needs of PLWHA in low income countries.
Collapse
|
12
|
Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr 2012; 59:409-16. [PMID: 22107822 DOI: 10.1097/qai.0b013e31824150bb] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Traumatic life histories are highly prevalent in people living with HIV/AIDS and predict sexual risk behaviors, medication adherence, and all-cause mortality. Yet the causal pathways explaining these relationships remain poorly understood. We sought to quantify the association of trauma with negative behavioral and health outcomes and to assess whether those associations were explained by mediation through psychosocial characteristics. METHODS In 611 outpatient people living with HIV/AIDS, we tested whether trauma's influence on later health and behaviors was mediated by coping styles, self-efficacy, social support, trust in the medical system, recent stressful life events, mental health, and substance abuse. RESULTS In models adjusting only for sociodemographic and transmission category confounders (estimating total effects), pasttrauma exposure was associated with 7 behavioral and health outcomes including increased odds or hazard of recent unprotected sex [odds ratio (OR) = 1.17 per each additional type of trauma, 95% confidence interval = 1.07 to 1.29], medication nonadherence (OR = 1.13, 1.02 to 1.25), hospitalizations (hazard ratio = 1.12, 1.04 to 1.22), and HIV disease progression (hazard ratio = 1.10, 0.98 to 1.23). When all hypothesized mediators were included, the associations of trauma with health care utilization outcomes were reduced by about 50%, suggesting partial mediation (eg, OR for hospitalization changed from 1.12 to 1.07), whereas point estimates for behavioral and incident health outcomes remained largely unchanged, suggesting no mediation (eg, OR for unprotected sex changed from 1.17 to 1.18). Trauma remained associated with most outcomes even after adjusting for all hypothesized psychosocial mediators. CONCLUSIONS These data suggest that past trauma influences adult health and behaviors through pathways other than the psychosocial mediators considered in this model.
Collapse
|
13
|
Troeman ZCE, Spies G, Cherner M, Archibald SL, Fennema-Notestine C, Theilmann RJ, Spottiswoode B, Stein DJ, Seedat S. Impact of childhood trauma on functionality and quality of life in HIV-infected women. Health Qual Life Outcomes 2011; 9:84. [PMID: 21958030 PMCID: PMC3198878 DOI: 10.1186/1477-7525-9-84] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL) in HIV. METHODS The present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL) by evaluating 85 HIV-positive (48 with childhood trauma and 37 without) and 52 HIV-negative (21 with childhood trauma and 31 without) South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Patient's Assessment of Own Functioning Inventory (PAOFI), the Activities of Daily Living (ADL) scale and the Sheehan Disability Scale (SDS). Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Childhood Trauma Questionnaire (CTQ). RESULTS Subjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA) demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count. CONCLUSIONS In assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.
Collapse
Affiliation(s)
- Zyrhea C E Troeman
- South African Research Chairs Initiative (SARChI), PTSD program, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Johnson BT, Redding CA, DiClemente RJ, Mustanski BS, Dodge B, Sheeran P, Warren MR, Zimmerman RS, Fisher WA, Conner MT, Carey MP, Fisher JD, Stall RD, Fishbein M. A network-individual-resource model for HIV prevention. AIDS Behav 2010; 14:204-21. [PMID: 20862606 PMCID: PMC4361779 DOI: 10.1007/s10461-010-9803-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual's relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual's current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks.
Collapse
Affiliation(s)
- Blair T Johnson
- Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
El-Bassel N, Jemmott JB, Landis JR, Pequegnat W, Wingood GM, Wyatt GE, Bellamy SL. National Institute of Mental Health Multisite Eban HIV/STD Prevention Intervention for African American HIV Serodiscordant Couples: a cluster randomized trial. ACTA ACUST UNITED AC 2010; 170:1594-601. [PMID: 20625011 DOI: 10.1001/archinternmed.2010.261] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) has disproportionately affected African Americans. Couple-level interventions may be a promising intervention strategy. METHODS To determine if a behavioral intervention can reduce HIV/sexually transmitted disease (STD) risk behaviors among African American HIV serodiscordant couples, a cluster randomized controlled trial (Eban) was conducted in Atlanta, Georgia; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania; with African American HIV serodiscordant heterosexual couples who were eligible if both partners were at least 18 years old and reported unprotected intercourse in the previous 90 days and awareness of each other's serostatus. One thousand seventy participants were enrolled (mean age, 43 years; 40% of male participants were HIV positive). Couples were randomized to 1 of 2 interventions: couple-focused Eban HIV/STD risk-reduction intervention or attention-matched individual-focused health promotion comparison. The primary outcomes were the proportion of condom-protected intercourse acts and cumulative incidence of STDs (chlamydia, gonorrhea, or trichomonas). Data were collected preintervention and postintervention, and at 6- and 12-month follow-ups. RESULTS Data were analyzed for 535 randomized couples: 260 in the intervention group and 275 in the comparison group; 81.9% were retained at the 12-month follow-up. Generalized estimating equation analyses revealed that the proportion of condom-protected intercourse acts was larger among couples in the intervention group (0.77) than in the comparison group (0.47; risk ratio, 1.24; 95% confidence interval [CI], 1.09 to 1.41; P = .006) when adjusted for the baseline criterion measure. The adjusted percentage of couples using condoms consistently was higher in the intervention group (63%) than in the comparison group (48%; risk ratio, 1.45; 95% CI, 1.24 to 1.70; P < .001). The adjusted mean number of (log)unprotected intercourse acts was lower in the intervention group than in the comparison group (mean difference, -1.52; 95% CI, -2.07 to -0.98; P < .001). The cumulative STD incidence over the 12-month follow-up did not differ between couples in the intervention and comparison groups. The overall HIV seroconversion at the 12-month follow-up was 5 (2 in the intervention group, 3 in the comparison group) of 535 individuals, which translates to 935 per 100,000 population. CONCLUSION To our knowledge, this is the first randomized controlled intervention trial to report significant reductions in HIV/STD risk behaviors among African American HIV serodiscordant couples. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00644163.
Collapse
Affiliation(s)
- Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Eban HIV/STD risk reduction intervention: conceptual basis and procedures. J Acquir Immune Defic Syndr 2008; 49 Suppl 1:S15-27. [PMID: 18724186 DOI: 10.1097/qai.0b013e318184255d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the Eban HIV/STD Risk Reduction Intervention being evaluated in the NIMH Multisite HIV/STD Prevention trial for heterosexual African American couples, including the integrated theoretical framework, the structure, core elements and procedures of the intervention, and how the content was shaped by culturally congruent concepts to address the needs of the study target population. DESIGN The Eban HIV/STD Risk Reduction Intervention is designed to address multilevel individual-, interpersonal-, and community-level factors that contribute to HIV/STD transmission risk behaviors among heterosexual African American couples who are HIV serodiscordant. METHODS The Eban HIV/STD Risk Reduction Intervention employs a mixed modality, couple-based approach that is based on an integrated ecological framework incorporating social cognitive theory and uses an Afrocentric paradigm that is informed by previous evidence-based couples HIV prevention interventions. For this randomized controlled trial, African American serodiscordant couples were recruited from 4 urban sites (Atlanta, Los Angeles, New York, and Philadelphia) and were randomized to either the Eban HIV/STD Risk Reduction Intervention (treatment condition) or a Health Promotion Intervention that served as an attentional control condition. Both interventions had 4 individual couple sessions and 4 group sessions, but only the treatment condition was focused on reducing HIV/STD risk behaviors. Behavioral and biological data were collected at baseline, immediately after the intervention, and at 6 and 12 months. The theoretical framework, core elements, and content of each session are described and lessons learned from this intervention trial are discussed. RESULTS An HIV prevention intervention combining couple and group sessions can be feasibly implemented with African American HIV-serodiscordant couples who remain at high risk of HIV/STD transmission. The lessons learned from the trial suggest that the participants responded very well to both the couple and the group sessions. Participant feedback suggests that the cultural congruence of the intervention and use of African American cofacilitators made them feel comfortable disclosing risky behaviors. Participant feedback also suggests that the intervention's couple-based focus on enhancing dyadic communication and decision-making skills was key to helping the couples work together to overcome barriers to using condoms. CONCLUSIONS Participant and facilitator evaluations of the Eban Risk Reduction Intervention suggest that couples responded well to the Afrocentric content and mixed modalities of the intervention sessions. Couple sessions were optimal for enhancing interpersonal and microlevel factors, including communication, problem solving, and decision making.
Collapse
|
17
|
Abstract
OBJECTIVE To provide an overview of the National Institute of Mental Health Multisite HIV/sexually transmitted disease (STD) Prevention Trial for African American Couples conducted in 4 urban areas: Atlanta, Los Angeles, New York, and Philadelphia. The rationale, study design methods, proposed data analyses, and study management are described. DESIGN This is a 2-arm randomized trial, implementing a modified randomized block design, to evaluate the efficacy of a couples-based intervention designed for HIV-serodiscordant African American couples. METHODS The study phases consisted of formative work, pilot studies, and a randomized clinical trial. The sample is 535 HIV-serodiscordant heterosexual African American couples. There are 2 theoretically derived behavioral interventions with 8 group and individual sessions: the Eban HIV/STD Risk Reduction Intervention (treatment) versus the Eban Health Promotion Intervention (control). The treatment intervention was couples based and focused on HIV/STD risk reduction whereas the control was individual based and focused on health promotion. The 2 study conditions were structurally similar in length and types of activities. At baseline, participants completed an audio computer-assisted self-interview and interviewer-administered questionnaire and provided biological specimens to assess for STDs. Similar follow-up assessments were conducted immediately after the intervention, at 6 months, and at 12 months. RESULTS The trial results will be analyzed across the 4 sites by randomization assignment. Generalized estimating equations and mixed-effects modeling are planned to test: (1) the effects of the intervention on STD incidence and condom use and on mediator variables of these outcomes and (2) whether the effects of the intervention differ depending on key moderator variables (eg, gender of the HIV-seropositive partners, length of relationship, psychological distress, sexual abuse history, and substance abuse history). CONCLUSIONS The lessons learned from the design and conduct of this clinical trial provide guidelines for future couples-based clinical trials in HIV/STD risk reduction and can be generalized to other couples-based behavioral interventions.
Collapse
|
18
|
Screening Persons Newly Diagnosed With HIV/AIDS for Risk of Intimate Partner Violence. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2008; 14:420-8. [DOI: 10.1097/01.phh.0000333875.32701.ca] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
19
|
|
20
|
Beadnell B, Baker SA, Morrison DM, Huang B, Stielstra S, Stoner S. Change trajectories in women's STD/HIV risk behaviors following intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2006; 7:321-31. [PMID: 16802194 DOI: 10.1007/s11121-006-0043-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Three 16-month sexual risk-taking trajectories were identified in 287 women in an STD/HIV intervention study. The Risk Eliminator group reported no sex risk following intervention while the Risk Reducer group reported continuous drops over time. The High Risk group reported higher initial risk than the other two and no subsequent changes. The trajectory groups showed no between- or within-group effects of intervention exposure. Trajectory groups were compared on baseline characteristics. No differences were seen in demographics or STD/HIV knowledge. Compared to one or both of the other groups, the High Risk women reported more lifetime partners, recent paying partners, adult rape, and recent substance use. Their steady partners were more likely to be abusive, intoxicated during sex (as were the women themselves), and believed to be non-monogamous. The Risk Eliminator group differed from the other two by being less likely to report a history of childhood sexual abuse.
Collapse
Affiliation(s)
- Blair Beadnell
- School of Social Work, University of Washington, 4101 15th Ave. NE, Seattle, WA 98105-6299, USA.
| | | | | | | | | | | |
Collapse
|
21
|
|